Electroconvulsive Therapy (ECT)

According to the National Alliance on Mental Illness (NAMI), depression affects 15 million American adults each year, an estimated five to eight percent of the adult population. Most patients treated with antidepressants for depression do well. Unfortunately, there is a significant minority of people, who will either fail to respond or who will have only a temporary or partial response. Some patients who have been treated with multiple anti-depressants are still severely depressed.

Electroconvulsive therapy, or ECT, has been an effective procedure for many treatment-resistant mood disorder patients. At MUSC Health, clinicians have access to the latest equipment and are using the most effective evidence-based treatments. This not only improves the efficacy; but these treatments reduce some of the undesirable side effects associated with classic ECT, such as short-term memory loss or headaches.

Modern ECT has advanced so that treatment is extremely safe and well tolerated. Patients are under anesthesia. A muscle relaxant called succinylcholine is administered to completely relax muscles. Soft electrode patches are placed on the face and temple. A new ultra-brief pulse unilateral ECT sends a series of low-voltage currents, and only to one side of the brain. The procedure lasts for a few minutes. Patients are awakened and are generally able to go home within an hour.

Patients typically receive about ten treatments spaced out over a period of three to four weeks. Some patients return for maintenance treatments. These might be one per week, or one per month, or as infrequent as once per year.

All patients respond differently. Yet on average, at least 50 percent of even severely depressed patients show improvement.

Treatment Studies

We have two clinical research treatment studies that may be of interest for patients who meet criteria (see lists below).

The FEAST (Focally Administered Seizure Therapy) may be the next step in ECT. This method focuses stimulation in the frontal lobes of the brain for effective antidepressant treatment, while further reducing the risk of memory side effects than conventional ECT. Even if you may not be interested in the newest form of ECT, you may be a candidate for our control group, wherein you receive right unilateral ECT but get additional cognitive testing and a brain MRI.

FEAST Study Patient Criteria

Inclusion Criteria:

18 to 90 years of age

Diagnosis of major depressive episode

Pretreatment HRSD score less than or equal to 21

ECT indicated

Willing and capable of providing informed consent

Exclusion Criteria:

History of schizophrenia, schizoaffective disorder, other functional psychosis, or rapid cycling bipolar disorder

History of central nervous system illness or insult other than conditions associated with psychotropic exposure (e.g., tardive dyskinesia)

Alcohol or substance abuse or dependence in the past year (DSM-V)

Secondary diagnosis of a delirium, dementia, or amnestic disorder (DSM-V), pregnancy, or epilepsy

The second ECT study involves the study of electric current already used in clinical ECT. The first ECT treatment involves finding the smallest dose to induce a seizure. The following ECT treatment doses (i.e., ECT number 2, 3, 4,,5...) are related to the first ECT session. If we could improve the methods used to determine the dose to induce a seizure, we could then potentially lower the total amount of electricity given across an entire ECT course (commonly 10 treatments given three times a week). The cognitive side effects of ECT are linked to the overall charge and amount of electricity given. Thus, our overall goal is to find a new way to determine ECT dosing, and thus improve ECT overall. This study will not affect your care, but will help us continue to make ECT better.

Current ECT Study Patient Criteria

Inclusion Criteria:

18 to 90 years of age

Diagnosis of major depressive disorder, bipolar disorder, or any other mood disorder, history of schizophrenia, schizoaffective disorder, other functional psychosis, or rapid cycling bipolar disorder

ECT indicated

Willing and capable of providing informed consent

Exclusion Criteria:

History of neurological illness or insult other than conditions associated with psychotropic exposure (e.g., tardive dyskinesia)

Alcohol or substance abuse or dependence (other than tobacco) in the past month

Secondary diagnosis of a delirium, dementia, or amnestic disorder (DSM-IV), pregnancy, or epilepsy